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Clinical Trial
. 2010 Aug 11;5(8):e12082.
doi: 10.1371/journal.pone.0012082.

Clinical prediction rule for stratifying risk of pulmonary multidrug-resistant tuberculosis

Dalila Martínez  1 , Gustavo Heudebert, Carlos Seas, German Henostroza, Martin Rodriguez, Carlos Zamudio, Robert M Centor, Cesar Herrera, Eduardo Gotuzzo, Carlos Estrada
Affiliations
Clinical Trial

Clinical prediction rule for stratifying risk of pulmonary multidrug-resistant tuberculosis

Dalila Martínez et al. PLoS One. .

Abstract

Background: Multidrug-resistant tuberculosis (MDR-TB), resistance to at least isoniazid and rifampin, is a worldwide problem.

Objective: To develop a clinical prediction rule to stratify risk for MDR-TB among patients with pulmonary tuberculosis.

Methods: Derivation and internal validation of the rule among adult patients prospectively recruited from 37 health centers (Perú), either a) presenting with a positive acid-fast bacillus smear, or b) had failed therapy or had a relapse within the first 12 months.

Results: Among 964 patients, 82 had MDR-TB (prevalence, 8.5%). Variables included were MDR-TB contact within the family, previous tuberculosis, cavitary radiologic pattern, and abnormal lung exam. The area under the receiver-operating curve (AUROC) was 0.76. Selecting a cut-off score of one or greater resulted in a sensitivity of 72.6%, specificity of 62.8%, likelihood ratio (LR) positive of 1.95, and LR negative of 0.44. Similarly, selecting a cut-off score of two or greater resulted in a sensitivity of 60.8%, specificity of 87.5%, LR positive of 4.85, and LR negative of 0.45. Finally, selecting a cut-off score of three or greater resulted in a sensitivity of 45.1%, specificity of 95.3%, LR positive of 9.56, and LR negative of 0.58.

Conclusion: A simple clinical prediction rule at presentation can stratify risk for MDR-TB. If further validated, the rule could be used for management decisions in resource-limited areas.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

References

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